Healthcare Provider Details

I. General information

NPI: 1306755384
Provider Name (Legal Business Name): MOLLY MARIE CANNICI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 TRUMAN BLVD
OAKLAND NJ
07436-2025
US

IV. Provider business mailing address

109 TRUMAN BLVD
OAKLAND NJ
07436-2025
US

V. Phone/Fax

Practice location:
  • Phone: 201-873-4961
  • Fax:
Mailing address:
  • Phone: 201-873-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number26NR17417100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: